Oncofertility Program and Department of Gynaecology, Royal Children's Hospital, Melbourne, VIC, Australia.
Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia.
Front Endocrinol (Lausanne). 2023 Jun 19;14:1146476. doi: 10.3389/fendo.2023.1146476. eCollection 2023.
Fertility preservation is an important healthcare focus in the paediatric and adolescent population when gonadotoxic treatments are required. Ovarian stimulation (OS) resulting in oocyte cryopreservation is a well-established fertility preservation option in the adult population. It's utility, however, is little known in young patients. The purpose of this review was to synthesise the available literature on OS in patients ≤18 years old, to identify gaps in current research and provide suggestions for future research directions.
Using PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in English in Medline, Embase, the Cochrane Library and Google Scholar databases. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Two reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Characteristics of the studies, objectives and key findings were extracted and summarised in a narrative synthesis.
Database search and manual review identified 922 studies, 899 were eliminated based on defined exclusion criteria. Twenty-three studies were included and comprised 468 participants aged ≤18 years who underwent OS (median 15.2, range 7-18 years old). Only three patients were premenarchal, and four patients were on treatment to suppress puberty. Patients had OS for a broad range of indications including oncology treatment, transgender care and Turner syndrome. A total of 488 cycles of OS were completed, with all but 18 of these cycles (96.3%) successfully resulting in cryopreserved mature oocytes (median 10 oocytes, range 0-35). Fifty-three cycles (9.8%) were cancelled. Complications were rare (<1%). One pregnancy was reported from a female who had OS aged 17 years old.
This systematic review demonstrates that OS and oocyte cryopreservation is achievable in young females however there are only a few cases in the literature describing OS in premenarcheal children or those who have suppressed puberty. There is little proof that OS can lead to pregnancy in adolescents, and no proof that this can be achieved in premenarchal girls. Therefore it should be regarded as an innovative procedure for adolescents and experimental for premenarcheal girls.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=265705, identifier CRD42021265705.
当需要性腺毒性治疗时，生育力保护是儿科和青少年人群的重要医疗重点。在成年人群中，卵巢刺激（OS）导致卵母细胞冷冻保存是一种成熟的生育力保护选择。然而，其在年轻患者中的应用鲜为人知。本综述的目的是综合现有关于≤18 岁患者 OS 的文献，确定当前研究中的空白，并为未来的研究方向提供建议。
使用 PRISMA 指南，对 Medline、Embase、Cochrane 图书馆和 Google Scholar 数据库中以英文发表的所有相关全文文章进行系统文献回顾。搜索策略使用了与研究主题和人群相关的主题词和通用术语的组合。两名审查员独立筛选研究的入选资格、提取数据并评估偏倚风险。提取并总结研究的特征、目标和主要发现，以叙述性综合形式呈现。
数据库搜索和手动审查确定了 922 项研究，根据既定排除标准排除了 899 项研究。纳入了 23 项研究，共纳入 468 名≤18 岁接受 OS 的患者（中位数 15.2 岁，范围 7-18 岁）。仅有 3 名患者处于初潮前，4 名患者正在接受抑制青春期的治疗。患者进行 OS 的适应证广泛，包括肿瘤治疗、跨性别护理和特纳综合征。共完成了 488 个 OS 周期，除 18 个周期（96.3%）成功冷冻保存成熟卵母细胞（中位数 10 个卵母细胞，范围 0-35 个）外，其余均成功。53 个周期（9.8%）被取消。并发症罕见（<1%）。1 例 17 岁接受 OS 的女性报告了 1 例妊娠。
本系统综述表明，OS 和卵母细胞冷冻保存在年轻女性中是可行的，但是文献中描述初潮前儿童或抑制青春期的患者 OS 的情况很少。几乎没有证据表明 OS 可以导致青少年怀孕，也没有证据表明这可以在初潮前的女孩中实现。因此，它应该被视为青春期女性的创新程序，对于初潮前的女孩来说则是实验性的。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=265705，标识符 CRD42021265705。
